On July 2, 2014 the Centers for Medicare & Medicaid Services (CMS) released its annual proposed rule on dialysis payment and quality. This week, we address changes to the payment and its effect on patients’ access to dialysis. Next week, check back as we discuss proposed changes to quality measures that facilities are judged on.

As expected, CMS proposes to keep payment for dialysis services relatively flat in 2015. However, proposed changes to how CMS calculates annual updates to payment will result in a cut to rural dialysis facilities by half a percent next year and likely another half percent in 2016. This is because CMS is proposing to use more recent information on dialysis facility costs to determine how much they should be paying dialysis facilities.

In previous years, CMS used 2008 cost information, but facility costs have changed in recent years. In 2011, Medicare payment for dialysis services, staff wages, and drugs were bundled together into one payment. According to CMS, dialysis facilities are now spending less on drugs, but more on staff wages than in 2008. Therefore, CMS is proposing to weigh payment more heavily on staff wages and reduce the weight on drugs.

Impact on Rural Dialysis Facilities

While basing payment on more recent costs may be a fairer way to control federal health care spending, it will result in lower payments to facilities in areas where wages are typically lower and a small increase to dialysis facilities in areas where wages are higher. Wages are typically lower in rural areas because the cost of living is also less. Unfortunately, on average, rural facilities are already losing money on treatments for patients who have only Medicare and/or Medicaid as their insurance. Some dialysis providers have indicated that in the face of flat and declining payments by Medicare, Medicaid and even by some private insurance companies, they may decide to close some of their clinics that are losing money.

While we expect overall access to dialysis facilities to remain stable in the near term, the National Kidney Foundation is concerned that providers may decide to close clinics that are in rural areas, causing patients in those areas to have to travel even further to obtain dialysis care. Longer travel times for dialysis have been associated with an increase in death and hospitalization because patients are more likely to miss treatments when they have more challenges getting to dialysis. CMS is giving the public 60 days to comment on the proposed rule. Over the next several weeks, NKF will evaluate the impact of the proposed rule on patients’ access to care; particularly in rural areas. We will then offer recommendations on how CMS can modify its proposal to make sure that patients are able to receive high quality dialysis care near their homes.

How far do you have to travel to dialysis? Do you consider this to be a burden or do you frequently encounter difficulties getting to your scheduled appointment? Share your comments below.

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About nkf _advocacy

The National Kidney Foundation's advocacy movement is for all people affected by CKD, transplant candidates and recipients, living and potential donors, donor families and caregivers. We empower, educate and encourage you to get involved on issues relating to CKD, donation and transplantation.

I’ve been very fortunate insomuch as since I started on dialysis I’ve been going to a facility just a few miles from my home -in rural N. Texas-. Having to commute to a facility located in one of even the closest greater population centers would cause me great inconvenience and hardship (as would moving nearer one as my housing, home health care and other factors are set up for my convenience and to my satisfaction.) A longer commute would expose me to greater fatigue on top of that already caused by the treatments themselves.

My unit just handed the 32 patients they serve in the rural community of Oneida NY a letter on June 30th telling us that the unit has until July 31, 2014 to vacate the building they lease from Oneida Healthcare. I was furious and sent a letter to the CEO of Oneida Healthcare admonishing him for throwing my unit out with such short notice. I am sending along a copy of BOTH the letter from the operators of my unit, Faxton St Lukes Hospital and the reply I received from Gene Morreale, CEO of Oneida Healthcare.
Mr. Morreale,
My name is Deborah Anderson-Gaiser. I have Stage 5 kidney failure and rely on dialysis to keep myself alive.
I am a life long resident of the Oneida area. I currently live in Vernon NY

This letter was given to myself and 31 other dialysis patients this morning. It reads as follows: Dear Oneida Dialysis Patient, Faxton St Lukes Healthcare has received notification from the owner of the building which houses our Oneida Dialysis Treatment Center that we must vacate the space no later than Thursday, July 31, 2014. Our team is working on a transition plan for your care and you will be assigned to another FSLH outpatient facility, We will do our best to make the transition as smooth as possible, recognizing that we may not be able to accommodate the same time of care that you currently have in our Oneida facility. We apologize for any inconvenience this may cause you and your family. If you have any questions or concerns please contact Kathy Nichols, case coordinator for Dialysis, at 315 624 5612 or myself. Thank you for your patience and understanding. Lila Studnicka, Executive Director, Renal Dialysis Services, 315 624 5640.

The building is owned by the company you are CEO of, Oneida Healthcare. Apparently their so-called “Circle of Care” doesn’t extent to the 32 people who rely on the Oneida Dialysis Unit to stay alive. The options we were given are as follows: Drive to Utica (60 mile round trip) drive to Hamilton (60 mile round trip) Drive to Herkimer (100 mile round trip) or Rome (45 mile round trip) to receive this life-support treatment. Also, we will most likely be put on the evening shift (5PM til 9:30PM) Meaning that on top of the 3 and a half hour to 4 hour treatments time, we will spend an additional hour just going to and from the other clinics.

Shame on you and your organization for making the lives and future of people who are struggling to stay alive by being hooked up to life support machines three times a week even more difficult by forcing us out into the street. Circle of Care indeed.

Deborah Anderson-Gaiser

AND, the response from Mr Morreale:

Dear Ms. Anderson-Gaiser,
Thank you for sharing your disappointment with Oneida Healthcare.
In my defense, we have been working with Faxton for over a year to relocate the dialysis program in our community. We offered our N. Main Street building to them as the new location for the dialysis program. That included leasing space or buying the space from us. Either would work well and accommodate the current program and allow room for growth, which is what they had requested of us.
We need the space in our building to expand our ENT practice as we have added a second physician. Again, Faxton has been aware of this for over a year and has failed to decide on a local presence. We have contacted them throughout the year trying to work out a deal. The eviction notice came only after they have failed to respond.
So, although we are asking the unit to relocate, you should also share your concern with the leadership at Faxton as their letter is misleading.
Gene F. Morreale, Chief Executive Officer
Oneida Healthcare Center | http://www.oneidahealthcare.org
321 Genesee Street | Oneida, New York 13421
Phone: 315.361.2300 | Email: gmorreale@oneidahealthcare.org

I work in a dialysis clinic and I know if patients needed to travel to my unit because theirs had closed it would be an hour one way. This definitely would cause patients to miss their treatments. Not only because of time, but also the money for gas.

I do not feel this is fair to yhose in rural areas that already have so many challenges and obstacles. Everyone should be able to recieve equal services and not have their lives jepordized. It makea no since to spend more on gas and transportation and allow these rural centers to be closed down. Take the money it will cost for transportation and give it to the centers so they can remain open and convenient for the clients that need this life saving service instead of putting them at a higher risk. Are the folks in rural areas lives less valuable then those who live in cities? A

The idea of a dialysis unit closing breaks my heart. After reading this article it struck me as weird that dialysis providers would close units because they are losing money. I had always assumed that dialysis providers like Davita were non-profit. I mean who would knowingly provide a service that people would die without and try to make a buck off of it. Its bitter sweet because I see dialysis centers like Davita popping up all over the place which is amazing and I am so thankful that the access to care is growing. Being for-profit is what enables them to make money and open new clinics, but at the same time if they started to lose money they would just shut them down because it would be bad “for-profit.” Here is an interesting article I found that relates:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875752/

I don’t know maybe I am just naive to think these services shouldn’t be for-profit and have investors. Please, I welcome any enlightenment.